title: Immunosuppression modifications and graft outcome in patients with chronic allograft nephropathy.
abstract: OBJECTIVE
  This retrospective study was done to assess the efficacy and safety of immunosuppression conversion on progression of chronic allograft nephropathy.
  
  
  METHODS
  One hundred seventy-four cyclosporine-treated renal transplant recipients were studied. Patients were included if they had biopsy-proven chronic allograft nephropathy (mild to moderate) with a serum creatinine level of 300 micromol/L or less. The treatments groups were (1) mycofenolate mofetil and reduced-dosage cyclosporine (group MMF/CsA; n=132) and (2) azathioprine and reduced-dosage tacrolimus (group Aza/Tac; n=42). Patient records were checked for graft function, survival, and comorbidities after conversion.
  
  
  RESULTS
  Mean follow-up before conversion was 52.2 -/+ 31.1 and 47.9 -/+ 27.4 month in groups MMF/CsA and Aza/Tac, respectively. There was a significant deterioration of graft function in group Aza/Tac after 5 years (P < .05). Ten-year actuarial graft survival in group MMF/CsA was 38%; in group Aza/Tac it was 19% (P = .04). Nine patients started dialysis within 12 months. Tacrolimus-treated patients had a lower insignificant incidence of hyperlipidemia (P = .05) but a significantly higher incidence of diabetes mellitus (P = .04). There were no significant changes or differences in blood pressure between the groups.
  
  
  CONCLUSIONS
  Our results suggest that in patientswith chronic allograft nephropathy and deteriorating allograft function, cyclosporine minimization and addition of mycofenolate mofetil achieve favorable effects in retarding the decline of graft function. Further prospective studies with larger cohorts are needed for validation.
authors.affiliation: Urology & Nephrology Center, University of Mansoura, Mansoura, Egypt. amgadelagroudy@hotmail.com
authors.forename: Amgad E
authors.initials: AE
authors.lastname: El-Agroudy
authors.forename: Khaled
authors.initials: K
authors.lastname: El-Dahshan
authors.forename: Khaled
authors.initials: K
authors.lastname: Mahmoud
authors.forename: Amani M
authors.initials: AM
authors.lastname: Ismail
authors.forename: Mahmoud
authors.initials: M
authors.lastname: El-Baz
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Shokeir
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Ghoneim
mesh_terms: D000328:Adult; D001379:Azathioprine / Q000009:adverse effects / Q000627:therapeutic use; D015331:Cohort Studies; D016572:Cyclosporine / Q000009:adverse effects / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006650:Histocompatibility Testing; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000601:surgery; D016030:Kidney Transplantation / Q000276:immunology* / Q000401:mortality / Q000473:pathology; D008297:Male; D009173:Mycophenolic Acid / Q000009:adverse effects / Q000627:therapeutic use; D011446:Prospective Studies; D012086:Reoperation / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D016019:Survival Analysis; D016559:Tacrolimus / Q000009:adverse effects / Q000627:therapeutic use; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D009173:Mycophenolic Acid; D001379:Azathioprine; D016559:Tacrolimus